Dental Sleep Treatment Requires a Medical Diagnosis. Or Does it?

Access to sleep diagnostic services are the limiting factor for dental patients who suspect that they have sleep apnea and require sleep treatment. In recent years changes to insurance reimbursement and insurance qualification requirements have only made the issue much worse.

His analysis of the US sleep field was very telling. Dr Flemons
team identified that in 2001 there were 280 million people in the United
States. At that time there were estimated to be 1,292 sleep clinics conducting
1.17 million in lab polysomnograms.

This is about 427 PSG’s per 100,000 population. The Veteran’s
Health Administration (VHA) was found to be under much more stress than the
public hospital system. In 2001 the VHA system cared for 3.75 million veterans
with only 55 sleep labs this resulted in only 160 studies per 100,000 patients.

The health risks associated with untreated snoring and sleep apnea
are well documented. Hypertension is perhaps the leading condition associated
with sleep apnea. Comorbid conditions include heart disease, stroke and
diabetes.

As recently report by the AASM “Frost & Sullivan calculated that the annual economic burden of
undiagnosed sleep apnea among U.S. adults is approximately $149.6 billion. The
estimated costs include $86.9 billion in lost productivity, $26.2 billion in
motor vehicle accidents and $6.5 billion in workplace accidents.”

There is no requirement that a
dentist initiate treatment however the patient must be advised of the
possibility of sleep apnea and a referral to a sleep physician should be made.
The challenge is that the access to diagnosis has continued to erode since the
early 2000”s when Dr Flemons’ data was collected.

With the change in guidelines by
the ADA we now have a total patient population of over 200M people that see
their dentist every year being screened for sleep disordered breathing. The ASA
says that 48% of these patients snore and 38% report having fallen asleep
unintentionally during the day at least once in the last month.

It is clear that treating the
patients symptoms as quickly as possible is the prudent choice for the dentist.
But how to do this without a medical diagnosis?

The Dental Solution

The answer may be provisional
treatment with a provisional mandibular advancement device (PMAD).

Patients with sleep related breathing disorders often present in the dental office with snoring as their primary complaint. And, chronic snoring is often associated with high risk of sleep apnea.

But, sleep apnea is a condition
that can be life threatening and is required to be diagnosed by a sleep
physician using specialized equipment that is not available everywhere, or is
in high demand due to the prevalence of sleep related breathing disorders in
the general population. These wait times can result in treatment delays of six
months or more.

Therefore it is prudent patient
care to treat the patient’s snoring symptoms immediately, in the dental office,
and refer for diagnostics and management by a physician as soon as possible.
From a medical legal perspective an informed consent document is required to
confirm that the patient is aware that they are being treated provisionally,
that they understand that their condition has medical risks and they need to
consult with a physician.

Dr Ken Berley DDS, JD, a practicing dentist and attorney, has spent some time examining the concept of provisional therapy. He has also prepared an informed consent document that is available for free download

A provisional treatment is
fundamentally no different from traditional mandibular advancement therapy for
airway management.

The tools and the techniques are in
fact the same. The major distinction is that with provisional therapy medical
insurance is not an option because there is no diagnosis or prescription for a
therapeutic device.

The patient will pay for the
therapy out of pocket and cost of the therapy will play a role in treatment
acceptance.

Once a diagnosis is made by a sleep
physician the dentist can replace the provisional appliance with more durable
long term appliance that meets medical insurance reimbursement guidelines and
clinical goals established by the dentist and the patient.

From a practice management
perspective treatment of patients provisionally will open many more patients up
to sleep treatment. It is estimated that there are 2.5 million people in the US
that have sleep apnea. The American Academy of Otolaryngology-head and Neck
Surgery report that nearly half of
adults snore, and over 25 percent are habitual snorers. With an estimated 211M
Americans seeing the dentist every year the opportunity for dentists to make a
difference in their patients overall health has never been more attainable.

Randy Clare brings to The Sleep and Respiratory Scholar more than 25 years of extensive knowledge and experience in the sleep and pulmonary function field. He has held numerous management positions throughout his career and has demonstrated a unique view of the alternate care diagnostic and therapy model. He is considered by many an expert in the use of a Sleep Bruxism Monitor in a dental office.
Mr. Clare's extensive sleep industry experience assists Sleepandrespiratoryscholar in providing current, relevant, data-proven information on sleep diagnostics and sleep therapies that are effective for the treatment of sleep disorders.
Mr Clare is a senior brand manager for Glidewell Dental Laboratory his focus is on dental treatment for sleep disordered breathing.

Author

Randy Clare brings to The Sleep and Respiratory Scholar more than 25 years of extensive knowledge and experience in the sleep and pulmonary function field. He has held numerous management positions throughout his career and has demonstrated a unique view of the alternate care diagnostic and therapy model. He is considered by many an expert in the use of a Sleep Bruxism Monitor in a dental office.
Mr. Clare's extensive sleep industry experience assists Sleepandrespiratoryscholar in providing current, relevant, data-proven information on sleep diagnostics and sleep therapies that are effective for the treatment of sleep disorders.
Mr Clare is a senior brand manager for Glidewell Dental Laboratory his focus is on dental treatment for sleep disordered breathing.